Covered & Cared For

For more than a month, a student in Alma
Vela’s first grade classroom at Washington
Elementary in Woodburn complained of
a toothache. Sometimes, the pain would
bring the young girl to tears. When the pain
became so unbearable she couldn’t concentrate in class, the student was sent home
with an application of OraGel — which was
really the only form of dental care she’d
ever known.

Because of her immigration status, Vela’s
student had gone her first seven years without having ever seen a dentist. On this occasion, she ended up missing several days
of school because of the pain — and the
toothache became a big point of conversation at parent-teacher conferences later
that month. It’s not unusual that health issues percolate in Vela’s relationships with
her students and their families, particularly
because of the community in which she
teaches, which has the highest population
of undocumented families and children
in the state. Many parents come to rely on
Vela for sharing resources on where to turn
for healthcare when their student lacks the
insurance to visit a doctor or a dentist.

“I have to put myself in their shoes —
healthcare is not just something that only
affects the individual student. It affects the
entire family,” Vela says.

For Vela — seeing her students struggle to
access the healthcare they need brings the
memories flooding back from her own childhood. Her own mother immigrated from
Mexico to Woodburn with four daughters,
and a year after their border crossing, Vela
was born. Because she was the only natural-born United States citizen in her family,
Vela was enrolled in the Oregon Health Plan
while her four other sisters went uninsured.
Though she had insurance, she moved
through her childhood in same manner that
her older sisters did — rarely seeing a doctor
unless the matter was urgent.

“I only went to a doctor when it was severe. Even though I did have coverage, it
was very difficult for my mom to get out and
make appointments, or be informed of the
resources that were available then,” Vela
says.

THE OFFICE OF EQUITY AND INCLUSION VALUES HEALTH FOR ALL OF OREGON'S CHILDREN. NOT ONLY WILL ENSURING THAT ALL CHILDREN HAVE QUALITY...

— Office of Equality and Inclusion

THERE’S HOPE

This year, undocumented students like
Vela’s are on the brink of a major shift as far
as their healthcare is concerned. House Bill
2726 — also referred to as the Cover All Kids
legislation — will ensure that a child’s access to health insurance is not determined
by immigration status. If the bill passes this
Legislative session, all children under the
age of 18 — documented and not — will have
access to health insurance through the Oregon Health Plan. An additional 17,600 kids will gain insurance if the bill passes.

On Feb. 20, Gov. Brown testified in support of the Bill in front of the House Committee on Health Care. "It is our duty to ensure that our youngest Oregonians have the
tools to grow into healthy adults with access to education, health care, and a bright
future," Brown was quoted in the Statesman Journal. "Oregon children should have
the opportunity to be healthy and ready to
learn, and Oregon families should feel con-
dent that a medical event will not dramatically change the trajectory of their lives."
The Bill’s chief proponent is the Oregon
Latino Health Coalition (OLHC), a collaborative group of 90-plus individuals and
organizations (including the Oregon Education Association) dedicated to promoting
health and wellness and reducing Latino
health disparities through advocacy, prevention, education, and sharing of resources. On a policy front, the Coalition develops
statewide legislation that will reduce disparities within Latino communities. Their
work began with a legislative campaign in
2015 to bring health care to all children,
which became the launch pad for the 2017 legislation currently under consideration.

The Coalition sites important facts for
prioritizing the Bill — namely, educational
outcomes. According to studies done by
Harvard and Cornell Universities, insured
kids are 9.7 percent less likely to drop out
of high school and 5.5 percent more likely
to graduate from college. An OLHC report
published for the 2015 campaign states that
“Health insurance coverage for undocumented children could also help Oregon
close the achievement gap. Low-income
children and children of color, a growing
share of the state’s student body, lag in their
educational achievement compared to
more affluent white children. The achievement gap threatens our economic competitiveness and our capacity to innovate.”
Over the past 10 years, the advent of the
State Children’s Health Insurance Program (SCHIP) and the increased push for
children’s coverage have led to marked declines in the number of uninsured children.
Nevertheless, a great deal of work remains
to be done. While the Affordable Care Act
extended affordable insurance options
to millions of Americans, undocumented immigrants have been left out of health reform. The most recent Census data show
that, for the first time since 1998, the rate
of uninsured children has increased, going
from 10.8 percent to 11.2 percent. One in
nine children is uninsured, with more than
half of all uninsured children living in two-parent families.

A DIFFERENT CHILDHOOD

Those numbers hit home for Aldo Soldano, the Campaign Community Organizer
for the Oregon Latino Health Coalition and
graduate of Woodburn High School. Soldano immigrated to the U.S. with his family
when he was six years old, and grew up in
low-income farm worker housing. His family came seeking a better life for their children, and in Woodburn, they found it — but
not without its own struggle, too.

Soldano remembers how cautious his
childhood was. He never played sports because he couldn’t risk getting injured without family health insurance. He laughs as
he remembers secretly longing to break an arm so that he’d get to come to school with
a cast and have his classmates sign it. “It’s
kind of a rite of passage. I remember thinking, I want to break my arm, but I knew that
if I did, I wasn’t going to get a cast. In that
way, not having health insurance can really
take away from your childhood,” he says.

“I am fortunate that I have a mom who is
super resourceful. She understood what our
situation was, in terms of status, and what
we qualified for. If there was a free clinic at
school, we'd get a quick check-up. A lot of
families just get by like that. But it's not consistent, it's not enough. It's not the type of
care that you really need to thrive,” he says.

When he turned 18, Soldano applied for
Deferred Action for Childhood Arrivals
(DACA), President Obama’s American immigration policy started in 2012 that allows
undocumented immigrants who entered the
country as minors to receive a renewable
two-year period of deferred action from deportation and eligibility for a work permit.
Through DACA, Soldano found full-time employment and, for the first time, qualified for
health insurance through his employer. “It
wasn't until I started working full-time and
got benefits that I ever saw a doctor. Prior
to that, I fully understood what the consequences were, and I understood the fear,” he
says of not having health insurance.

Soldano has been effective in his role as a
community organizer for the Cover All Kids
campaign because his situation is relatable.
“I know exactly what it’s like to go through
the school system and be a child without
care,” he says. “I meet with mothers of
young children, and they see that I’m not
just an outsider — that I understand where
they stand on this issue. It gives them a
sense of security that they can trust me.”

Soldano knows that even if the bill passes,
anxiety will continue to be an issue. The current anti-immigration climate in the era
of a Trump Administration has justifiably
instilled a sense of fear in families with undocumented children. The Trump Administration has said it plans to increase immigration enforcement efforts in the U.S., with
a particular focus on people living in the
country illegally. This has hit the community of Woodburn particularly hard in recent
weeks — in February alone, federal immigration agents detained more than a dozen members of Woodburn’s Latino community.
Soldano says that for many families right
now, healthcare is synonymous with government, and government is not a friend. If
Cover All Kids becomes law, a big challenge
will be getting the information to families
to enroll their children in Medicaid — a
government program. Soldano says the responsibility will fall to community organizations who have developed trusting relationships with the communities they serve.
“Because of the political climate right now,
it wouldn't be strategic for enrollment purposes to do it solely through county services,” Soldano advises. He’s fully prepared for
the Oregon Latino Health Coalition to step
up to the plate and continue their outreach
and advocacy work to ensure the students
who need healthcare are getting it. Educators, he notes, also play an important role in seeing this step through.

HEALTHCARE MATTERS

On a Spring day at the Early College
High School (ECHS) in Salem, school nurse
Cindy Hoffert stops in to check on a few students she’s been asked to help triage. One of
these students is Isabela* (*Name changed
to protect privacy), an 18-year-old undocumented student in ECHS’s Teen Parent
Program.

Two years ago, while pregnant with her
daughter Aaliyah, Isabela was diagnosed
with Graves Disease, an autoimmune disease of the thyroid. If she had not become
pregnant and been covered by insurance
for those nine months, Isabela's condition
may very well have gone undiagnosed. Now,
because she’s no longer covered by the Oregon Health Plan but is a legal adult (albeit
still a student), she is unable to access the
treatment she needs — though she continues to struggle daily with symptoms of the
disease, like severe swollen throat, glassy
eyes, weight gain and low energy.

From time to time, Isabela has been able
to access the low-income clinics in Salem
and the surrounding areas for immediate health concerns. Still, she walks away
with a minimum $500 bill after each visit.
Some issues go untreated — she’s using a
4-year-old inhaler to treat her asthma and
suffers anxiety — all while raising a toddler and attending school full time. Hoffert says
the Cover All Kids legislation could make
a world of difference for a student like Isabela – and for all the migrant students with
whom she meets daily.

For Alma Vela, returning to
teach in the community where
she grew up was always top
priority. "Woodburn is where
my heart is," she says.

Year after year, Hoffert’s school nurse
caseload continues to grow. She’s been
working as a nurse in Salem-Keizer secondary schools for 16 years, and currently
serves North Salem, McKay, and all of Salem's alternative high schools. Each of the
school nurses in Salem averages a caseload
of around 3,500 students per nurse. “That’s
just sheer numbers — but then we add in
the kids who require tube feedings, insulin
shots and other issues that require you to be
physically present for them every day,” Hoffert says. A large part of Hoffert’s day-to-day
work is helping families navigate how to get
a very sick child the care they need.

The first question she often must ask is:
“Are you documented?”

“The reason I have to ask is because I don’t have as many options for you, if you
aren’t,” Hoffert says. “I used to feel really
bad telling parents that — but now I can say,
‘my hands are tied and it’s no one’s fault’.”
Every year, she calls around to various clinics to see if there are any new resources for
immigrant families, but each year, the available resources seem to dwindle, even from
where they were 10 years ago.

When she hits a dead end, she’ll reluctantly tell a family that the only remaining
option is the emergency room, which cannot deny care to anyone, no matter their immigration status — though Hoffert knows
full well they’ll end up with a bill of at least
$2500 from the visit. Of the new legislation,
Hoffert has hopes that it will result in more
preventative care from the outset, lessening the need for those costly ER visits.

A WORTHY INVESTMENT

Of course, legislation like this comes with a price tag — currently estimated at
$55 million. Soldano says there are creative
ways through revenue reform to fund both
this program and other valuable services
in jeopardy right now. Gov. Brown has included the expansion in her proposed budget, allocating $55 million in General Fund
money for 2017-2019.

Studies done by the American Journal of
Public Health have repeatedly demonstrated that the uninsured are less likely than
those with insurance to receive preventive
care and services for major health conditions and chronic conditions. The Oregon
Latino Health Coalition says the Bill will ensure access to health care prevents treatable
illnesses from becoming expensive health
care crises — saving the state money in the
long-term. Similar policies to Cover All Kids
are already in place in California, Washington, New York, Illinois and Massachusetts.

While the Bill has broad bipartisan support, it also faces some staunch criticism from anti-immigration groups, who cite
Oregon’s $1.8 billion budget gap as the primary reason to vote against the legislation.
That view, many say, is short-sighted, noting that investment in primary care lessens
costs over time, and the addition of 17,000
children to the Oregon Health Plan would
represent just over 1 percent of the entire
plan’s population.

The proposed legislation has a broad
swath of Republican support, however;
Rep. John Huffman, a Republican from The
Dalles and co-sponsor of the legislation,
said the insurance expansion “makes sense
morally and economically — morally, because I have always advocated for supporting our most vulnerable, and economically,
because healthy kids miss less school and
their parents miss fewer days of work.”

For Soldano and Hoffert, the issue comes
down to equity for all students. “There is this
little voice stuck on the conversation of immigration, and using the ‘I’ word to define
these kids. That's not giving them the place
they deserve. It is a dehumanization of the
issue from what it really is,” Soldano says.

Hoffert agrees, and says Cover All Kids
could level the playing field for our students
— and educators alike. “If we have 40 kids,
37 might have health insurance and three
don’t. Those three students aren’t equal,
but they should be. They are a part of our
school community; they undergo the same
level of rigor that all other students do, but
they lack the access to the services that
other students have.” Ensuring all students
regardless of immigration status have equal
access to healthcare could make the work
of educators and school nurses that much
more seamless and effective, too, Hoffert
says. She looks forward to the day when she
can approach each of her students’ needs
from the same lens and provide each of
them the same resources.

“When families make that huge decision
to come to this country — it’s a leap of faith
and they do it for their kids,” Soldano says.
“If their children are not able to perform to
their full potential, it takes away from the
entire purpose of coming here. They took
all these risks and left everything behind,
but their child is far from receiving the care
they need to thrive and push their family
out of poverty.”